mHealth delivered narrative intervention to increase cervical cancer screening among Malawian Women living with HIV

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Cervical cancer (CC) is the leading cause of morbidity and mortality among women living with HIV (WLWHIV) in Malawi. Screening and treating women with precancerous lesions has been shown to be highly effective in the prevention of CC but the availability of CC screening does not automatically translate into their utilization among WLWHIV. . Prevention of HPV-related cervical cancers in WLWHIV, particularly in the context of resource-constrained settings where prevention-oriented services are either lacking or the health beliefs of the population are oriented toward the treatment of acute illness is problematic. Culturally tailored and evidence- based interventions to increase screening uptake is needed. Storytelling narrative interventions hold particular promise as a means to engage vulnerable (often low-literacy) populations in positive health behaviors including cancer screening. In addition, narrative interventions such as storytelling made available through social media holds the promise of engaging WLWHIV in more active participation in health prevention/self-management. This study addresses the following specific aims: Phase I: Developmental Phase: Develop intervention Specific Aim 1: We will develop an interactive, multi-media intervention based on authentic stories from Malawian WLWHIV, local community leaders, and Malawian health care providers that encompasses targeted health messages that are consistent with the situation-specific theory and the desired behavior (CC screening). Phase II: Implement Phase: Conduct a pilot randomized clinical trial (RCT) Specific Aim 2: We will conduct a pilot RCT with three groups (Arm 1: Storytelling Narrative+mHealth; Arm 2: mHealth; and Arm 3: Attention control; N=180) to assess the feasibility, acceptability, and preliminary effectiveness of a narrative intervention delivered by mHealth (tablets) among WLWHIV. We will select 15 established HIV support groups within the rural areas of the Lilongwe district of Malawi and randomly assign the group to an intervention strategy (Arms 1, 2, or 3). Within each selected HIV support group, 12 WLWHIV who are willing to participate in the study will be prospectively enrolled. The findings and experiential learning gained from this study will lay the foundation for a larger trial that can test the effectiveness of the intervention. Although the proposed implementation strategy is evidence-informed and promising, its use is novel in HIV support group settings and in mHealth delivery. There needs to be feasibility testing in the mHealth setting prior to a larger-scale evaluation of its effectiveness in a low-income country. This project is innovative in that it attempts to integrate CC screening into the HIV support group system already in place in Malawi and develops a locally tailored novel narrative intervention that is culturally and literacy sensitive. The proposed study is significant because of its potential to improve CC prevention by equipping Malawian WLWHIV with self-confidence with cultural and evidence-based strategies to increase CC screening uptakes.